NCQA Introduces Specialty Medical Practice Certification, PCSP

By Debra Wood, RN, contributor

March 27, 2013 - Based on the success of its Patient-Centered Medical Home (PCMH) Recognition and the realization that primary care practices must, but often don’t, work collaboratively with specialists, the National Committee of Quality Assurance (NCQA) has released standards for its new Patient-Centered Specialty Practice (PCSP) Recognition.

Margaret E. O'Kane: PCSP distinguishes specialty practices for care coordination
Margaret E. O’Kane, president of NCQA, said the new Patient-Centered Specialty Practice will distinguish practices committed to coordinating care and reducing waste.

“The program recognizes specialists who meet high standards for care coordination,” said Margaret E. O’Kane, president of NCQA. “It’s an area of delivery system reform that promises to save money and improve quality. Any patient who sees more than two doctors understands the importance of coordination.”

O’Kane reported that the typical primary care provider coordinates with 229 physicians in 117 practices. The average Medicare beneficiary sees seven physicians and fills more than 20 prescriptions per year. Older adults receive an average of two referrals per year.

“The opportunity for gaps to emerge among all those complex relationships or things to happen that are in conflict with each other is great,” O’Kane said.

Visits to specialists constitute more than half of all outpatient physician visits. Primary care physicians report sending information to specialists 70 percent of the time when they refer, yet specialists report receiving such information only 35 percent of the time. Communication is slightly better in the other direction, with specialists reporting they send primary care physicians a report 81 percent of the time, and primary care providers indicate they receive one 62 percent of the time.

“We know if we can set up systems, we can prevent this sort of leakage,” O’Kane said.

To address the disconnect between primary care physicians and specialists, NCQA convened an advisory committee to develop the specialty program, which will build on the success of NCQA’s Patient-Centered Medical Home Program, which has recognized more than 26,000 primary care clinicians in 5,497 sites as having successfully met its standards.

Medical homes lead to improved quality and patient satisfaction and reduced cost of care, by avoiding hospitalizations and emergency department visits, O’Kane said. In addition, clinician burnout is reduced due to the organizational improvements.

“This program has the promise to do what the Patient-Centered Medical Home Program did, which is to focus the effort, to be able to articulate and give a blueprint to specialty offices and give something to measure progress,” said John Blair, MD, president of the Taconic Independent Practice Association in Fishkill, N.Y. “We will take this and roll it out, as we have with the Patient-Centered Medical Home Program.”

The specialty program also incorporates the American College of Physicians (ACP) Primary-care Medical Home Neighbor (PCMH-N) concept, released in 2010, which defined the neighborhood and relationships with specialty practices and the use of care coordination agreements.

“In order for care coordination to improve between practices, major changes must take place within practices,” said Carol Greenlee, MD, co-chair of the ACP PCMH Neighbor Work Group and an endocrinologist with Western Slope Endocrinology in Grand Junction, Colo. “It’s exciting that the focus is moving to all of us working together.”

Fifty-seven specialty practices have signed up as early adopters to NCQA’s Patient-Centered Specialty Practice program, including Western Slope Endocrinology.

The PCSP program’s six specialty practice standards include:

  1. Track and coordinate referrals
  2. Provide access and communication
  3. Identify and coordinate patient populations
  4. Plan and manage care
  5. Track and coordinate care
  6. Measure and improve performance

“A lot of specialists are somewhat thirsty for an external yardstick by which we can measure and aspire to get our practices up to speed,” said John Cox, DO, an oncologist with Texas Oncology – Methodist Dallas Cancer Center in Texas, another early adopter.

Cox and Greenlee said they believe even specialists who provide episodic care can benefit from better care coordination.

“It needs to be universal, and our goal will be 100 percent across all specialties,” Blair agreed.

O’Kane predicted payers will encourage primary care providers to refer to NCQA-recognized specialty practices, perhaps even allowing a bypass of preauthorization requirements for referrals to recognized practices, and that accountable care organizations (ACOs) would consider recognized specialty practices for participation in the ACO.

“It shows purchasers, both the public, private and pilot program sponsors, that specialists are ready to step up to the plate in the larger effort to integrate the healthcare system,” O’Kane said. “It distinguishes practices as committed to coordinating care and reducing waste.”

Blair agreed, adding that payers and ACOs are already looking at the program, and some health plans are considering tying it to specialty incentives in 2014.

Cox has been talking with referral physicians about how they share information and has found it beneficial and that formal agreements can have a positive effect on care.

NCQA will present educational seminars about the new PCSP recognition program and how to get started, beginning in July. It also will offer webinars for early adopters.


© 2013. AMN Healthcare, Inc. All Rights Reserved.